By Kevin Brown
Precision radiation medicine is a twenty-first century approach to fundamental cancer therapy.
Approximately 50-60 percent of cancer patients will receive radiation therapy at some point during their cancer journey, as it is used for curative regimens and palliative care. Radiation therapy has been a pillar of cancer treatment for most of the past century, yet far from being an old or unsophisticated technology, recent advances in radiation delivery technology and software automation have enabled a new era of personalized precision radiation medicine.
The ability to develop personalized radiation therapy regimens is a direct result of the increased precision and accuracy with which cutting-edge systems deliver radiation doses. These systems enable delivery of higher doses of radiation to tumors, which increases efficacy, while reducing exposure of normal tissue, which is essential for improving safety, tolerability and long-term toxicity. The improved targeting to tumors allows more radiation to be delivered during each treatment session, which results in fewer sessions, reduces patients’ treatment burden, and allows more patients to be treated on each delivery system. Importantly, improved targeting is also opening the door to the use of radiation therapy in hard-to-treat cancers that are not amenable to traditional radiation therapy approaches.
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Based on advances that allow the safe delivery of increased radiation doses, there is a growing trend toward the clinical use of hypofractionated regimens in which a total radiation dose is delivered over fewer treatment sessions. In addition to providing excellent outcomes, hypofractionated regimens may also have an important role to play in value-based approaches to cancer care because they reduce the total number of treatment sessions while providing excellent results.
The challenges of cancer care during the Covid-19 pandemic
The Covid-19 pandemic presents unique and diverse challenges to the safe and effective delivery of cancer care. A key challenge is that many cancer therapies, including chemotherapy and some targeted therapies, are immunosuppressive. Patients treated with these therapies have an increased risk of infection in routine treatment, and these regimens put patients at high risk of infection with SARS-CoV-2, the virus that causes Covid-19. The curtailing of non-emergency surgeries at most hospitals and cancer care centers is also upending standard of care cancer regimens that include surgery.